A 64-Year-Old Woman with Endometrial Cancer - Episode 5

Considerations for Second-Line Treatment Selection for Patients With Metastatic EC

Focusing on patients with recurrent metastatic endometrial cancer, an expert oncologist identifies factors that help inform the selection of second-line targeted therapy.

Bhavana Pothuri, MD:
Obviously, chemotherapy is the standard first-line treatment. For a dMMR [mismatch repair deficient] patient, immunotherapy is the standard of care. With response rates as high as 44%, and with that long duration of response, it’s safe to say that it’s the standard of care. With that, you have 2 choices that are FDA approved. Both are good choices, but my personal preference is dostarlimab. I find it very well tolerated with patients, and I have had a lot of experience with it, putting many patients on clinical trials with it. That’s my choice of therapy, but both are great choices.

In terms of the 2 drugs, there are not a lot of differentiators. Their efficacy, AE [adverse event] profile, discontinuation rate, and all that are quite similar. There aren’t any specific clinical factors. But 1 factor is you have to make sure of is if the patient a good candidate for immunotherapy. If they have severe underlying autoimmune diseases or are on steroids at very high doses, they may not be the best candidates for this. However, there are some clinical trials looking at patients who have these autoimmune diseases and treating them with immunotherapy. Once we have that data, we may be shifting the pendulum on utilization in those patients. But for now, it’s safe to say that those are some of the patients who I don’t necessarily treat without putting them on a clinical trial.

The typical response rates are similar to what’s been reported. I see long, durable responses as they have been reported in the trials KEYNOTE-158 as well as GARNET. In terms of the goal for these patients, everyone wants to get a CR [complete response], but CRs occur in about 10% of patients, even in the recurrent setting. There’s so much value in getting even a partial response with improvement in symptoms, or stable disease in patients who don’t have symptoms, and those are acceptable goals in recurrent metastatic disease.

It’s some of the things that we alluded to before: patients with more significant underlying comorbidities may have more adverse effects. Make sure you monitor those patients [because] they may not be able to tolerate the regimens as well, and their performance status may not be as good either. You have to take all that into account. As you’re treating these patients, you need to be very mindful of all that.

Transcript edited for clarity.